Successfully implementing Patient Reported Data: Lessons learned from failing fast and failing forward

Patient Reported Data (PRD) is a relatively new concept that is being embraced by thought-leading institutions based on its huge potential to improve patient experience and gain valuable insights into providing appropriate personalized care. High quality PRD has proven to improve health and financial outcomes. All of these benefits align with the Institute of Health Improvement Triple Aim, the gold standard for evaluating new initiatives.

However, like many healthcare software solutions, typical survey tools fail in their implementation to capture high quality PRD. Why does this happen? Why do less than 10% of patients fill out satisfaction surveys? Why do researchers who survey patients have to “clean” survey data?

In my past life as Medical Director of a Provincial Pediatric Emergency Department, I experienced this failure at collecting PRD first hand. We set up an eHealth triage system to collect PRD (documented by nurses on the computer) spent months training staff and then had to abandon it- the technology was adequate as a stand alone, it just didn’t work for either patients or providers. We believed in the “fail-forward-fast” approach to implementing solutions and were brave enough to publish our experience.

What did we learn? What are the secrets to successful PRD implementation?

There are critical considerations that are often neglected when the focus is implementing technology. Firstly, patients are people. If the goal is high quality PRD, the technology has to efficiently accommodate the diversity of patient populations with respect to language, culture, literacy and education. Secondly, healthcare systems are complex and the priority of healthcare staff should be the patient- not the technology. For success, healthcare organizations need each step of the implementation process to enhance patient and provider experiences efficiently and effectively, and the technology should support this.

Therefore successful uptake requires technology processes that are very user friendly for both providers and the diversity of a patient population, andproper implementation strategies that account for the complexity of the healthcare environment. New technology innovation can’t be a work around- it needs to fit easily into regular workflow practices. Intuitive technological design and understanding the user scenario are keys to success.

This is easy to recommend but much harder to do. It requires nuanced expertise. There are “hidden” costs that affect the ROI. What specifically am I speaking of? Successful uptake requires understanding the unique complexity of each healthcare system, it’s unique patient population, barriers and requirements prior to implementation. Implementation includes the human costs of training, the ease of uptake (onboarding), the ability for ongoing updates and the time taken during interaction. While a top down approach may force implementation, success will occur more rapidly and smoothly with bottom up endorsement and support. Carlfjord and Festin asked 470 healthcare providers what facilitated embracing and implementing new technology (a patient lifestyle tool). Their priorities were ease of use and learning, evidence based, and improved their current practice.

The technology needs to work for people, not in spite of them.

The good news is that if designed properly - from an embedded use case approach, technological patient engagement tools like those that collect high quality PRD can be effective, improve patient experience, improve care opportunities and meet meaningful use mandates. Our fail forward message is that healthcare organizations will save expenditures, energy and time if they realize to look beyond the widget to the both patient experience and provider implementation workflow processes before choosing new technological solutions.

Nina Chen